1. On-Line Library Maintain and Organize Favorites
John Behn, MPA
Laurie Daigle, CPC

2. On-line Libraries Retain most current policies and procedures
Easily organized by payor and product
Accessibility improves billing and follow-up speed and accuracy
Instant and current pre-authorization and drug approval information 2

3. Must Have Links for Medicare
Payor Policy Library
Must Have Links for Medicare
Transmittals
Manuals
NCDs and LCDs
CCI edits
Addendum B
Physician Fee Schedule Database
Clinical Lab Fee Schedule 3

4. Transmittals All transmittals organized by Year Ability to sort by:
CR# (Change Request Number)
Date
Transmittal Number
Searchable by date or word search
Example: New Patient Discharge 4

5. Internet Manuals Organized by publication number and description
Payor Policy Library
Internet Manuals
Organized by publication number and description
Detailed information on all Medicare changes and requirements
Observation 5

6. Medicare Coverage Database
Payor Policy Library
Medicare Coverage Database
Search: allows users to search NCDs and LCDs by keyword, topic date
Index: list of national and local coverage determinations
Reports: current reports of national and local coverage
Download: complete set of LCDs and articles, and NCDs 6

7. NCCI MUEs P to P edits (NCCI) Add-on code edits
x.html

8. Medicare Fee Schedules
Hospital
for-Service-Payment/Hospitaloutpatientpps/Downloads/2017-January- Addendum-B.zip
Physician
Payment/PhysicianFeeSched/index.html
Lab
Payment/ClinicalLabFeeSched/index.html
Proposed and Final Rules
Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and- Notices.html

9. Medicaid West Virginia
Provider Manual
Unicare Provider Manual
edical/notertiary/pw_a pdf

10. Provider Resource Center https://prc.highmark.com/rscprc/hwvbcbs/pub
Payor Policy Library
Blue Cross
Home Page
fm-home-page.html&docId=509&CSRFTOKEN=
Provider Resource Center
E subscribe
Radiology Prior Authorization
mgmt-prior- authorization.html&docId=1420&CSRFTOKEN= 10

11. United Healthcare
PreLoginMain&forwardToken=PreLoginMain
Prior Authorizations
nelId=12f8c7958f5fa010VgnVCM100000c520720a____
Manuals and Policies
nelId=ca174ccb4726b010VgnVCM100000c520720a____

12. Aetna http://www.aetna.com/healthcare-professionals/index.html
Clinical Policy Bulletins
Searchable, Alpha or numeric
bulletins.html
Newsletter
news/provider-newsletters.html
Manuals
education-manuals/provider-manuals.html

13. Cigna
Nav%3Bhealth-care-professionals
Policies
care-professionals/clinical-payment-and-reimbursement- policies/?WT.z_nav=healthcare- professionals%3BIWantTo%3BView%20Policies

14. Coding Resources Modifier fact sheets
resources/modifiers/
NDC to HCPCS Crosswalk
CPT Errata
corrections

15. Billing ANSI Codes http://www.wpc-edi.com/reference/ UB Fields

16. Help Tools Unit Conversion http://www.unitconversion.org/
Drug help tools 16

17. Supply HCPCS Cook - http://www.cookmedical.com/ccodes.do?sbu=esc
Payor Policy Library
Supply HCPCS
Cook -
American Medical Systems
eTile=corpweb&searchType=corpweb_all&currentPage=1&q=AMPLATZ
professionals/reimbursement.html
St Jude /15468sjmcrm reimbursementguidesheetr4fnlldrgb.pdf
Choose Cook The GPN G05183 to see if device dependant 17

18. Patient Assistance - Drugs
assistance/patient-assistance-foundation-enrollment
support.html

19. Additional Links Unit Conversion http://www.unitconversion.org/
Payor Policy Library
Additional Links
Unit Conversion
Drug help tools
Quest Diagnostics on
ACR Appropriateness Criteria 19

20. Payor Policy Library
Organize Favorites
From website, click “Favorites” in toolbar and choose “Add to Favorites”
Choose “New Folder” option and name by payor or tool grouping
Name of link can be changed to any name easily recognized 20

21. Choose “New Folder” option and name by payor or tool grouping
Organize Favorites
From website, click “Favorites” in toolbar and choose “Add to Favorites”
Choose “New Folder” option and name by payor or tool grouping
Name of link can be changed to any name easily recognized
Blue Cross Coding Commercial Help Tools Medicare 21

22. Maintain Library Maintain folder organization and naming conventions
Payor Policy Library
Maintain Library
Maintain folder organization and naming conventions
Remember to rename links using a consistent process that makes sense, so the link can be easily retrieved
If it takes more than a minute to find a link in your favorites, consider moving and renaming
Ask yourself where you looked, what name you searched and transfer or rename
Each time you perform an internet search, ask yourself if you will need the reference again and save only what you will need in the future 22

23. Thank You
Stroudwater Revenue Cycle Solutions was established to help our clients navigate through uncertain times and financial stress. Increased denials, expanding regulatory guidelines and billing complexities have combined to challenge the financial footing of all providers.
Our goal is to provide resources, advice and solutions that make sense and allow you to take action.
We focus on foundational aspects which contribute to consistent gross revenue, facilitate representative net reimbursement and mitigate compliance concerns. Stroudwater Revenue Cycle Solutions helps our clients to build processes which ensure ownership and accountability within your revenue cycle while exceeding customer demands.
Contact us to see how we can help.
Laurie Daigle, CPC
John Behn, MPA